The gray-haired woman convulsed in her hospital bed, her arms and legs twisted as her chest rose and fell into a fast bomb, bomb, bomb.
He was losing a war over the coronavirus reaching his body. Aided by an oxygen mask tied to her face (the woman had rejected a ventilator), the staff at Hermann Memorial Hospital at the Texas Medical Center aimed to make her feel more comfortable in her final days.
Two nurses lifted a blanket over the old woman’s shoulders after administering the powerful painkiller Fentanyl, her curly hair poking out from under the fleece. Within minutes, her breathing finally slowed.
Bomb … bomb … bomb.
Registered nurse Ivette Palomeque stepped out into the hospital’s silent ICU COVID-19 hallway and closed the sliding glass doors behind her. Around the horseshoe wing, 21 other patients filled each room.
Palomeque had just returned from New York, where she volunteered at Elmhurst Hospital in Queens. When he left Houston three months ago, case counts were low and most residents were ordered to stay home. After less than a week, she realized she had come out of one disaster area so it could be another.
“It’s troublesome to watch it, because I know what’s coming,” he said. “This is demoralizing.”
While the doctors and nurses at Memorial Hermann say they are still equipped to handle the increase in cases, the ICU beds at the hospital are nearly full, and all institutions at the Texas Medical Center are operating on a plan. “Phase 2” contingency to make use of more beds in overflow areas. With the plan in place, the total number of ICU beds used throughout the medical center is 1,367, including 512 for COVID-19.
Based on data from the medical center, there are an additional 840 ICU beds available under surge plans, and more capacity can be created by converting beds.
Houston is not yet in a New York-type situation, doctors agreed, and they hoped that the nation’s largest medical complex would not experience a collapse of the health system.
Models predict the disease will peak in mid-to-late July, nearly two months after cases began to escalate with the reopening of the Texas economy and a busy Memorial Day weekend. Texas has become one of the worst places in the nation for the spread, and all eyes are on the state and Houston as health and government leaders desperately try to stem the outbreak.
“It’s going to be a tough couple of weeks, but we’re going to get through this,” said Dr. Luis Ostrosky, an infectious disease expert at Memorial Hermann and UT Health.
The risk to medical professionals.
Dr. Pratik Doshi walked the halls of the 8th floor in the Sarofim Pavilion, a shiny glass building that accidentally opened in February before the pandemic landed in Houston.
He is the treating physician of the UCI COVID, which occupies half of the landing. In April, only 10 people occupied beds there, but he and his staff saw the numbers increase: 16 in May, then 22 in June, capacity. The influx forced Memorial Hermann to overflow patients into the medical ICU on the other half of the floor, occupying approximately three-quarters of the 16 beds there on Thursday.
Doshi had just completed his rounds, and went back through each room, separated from the hallway by a glass wall.
In a bed, a man made the sign of the cross, kissing his fist and pointing to heaven.
In another, a man hunched over and spoke on the phone.
In the surrounding rooms, other patients lay motionless.
Almost all beds were occupied by a patient with some form of breathing apparatus, oxygen support at best, extracorporeal membrane oxygenation machine at worst. Called ECMO, it takes over lung function by circulating blood outside and inside the body, said Dr. Bela Patel, executive medical director of critical care medicine at Memorial Hermann.
The youngest patient in the unit was a woman who had just given birth, Doshi said. She was diagnosed with COVID-19 and is seriously ill.
The hospital is quiet, despite the circumstances. The week-long activity in the unit would perhaps fill an episode of the television show “ER,” Doshi said. After months of working with the disease, they have found a pattern of functioning that works for them, even though more patients keep coming. On Friday, the hospital was not at its capacity of 38 ICU beds and 29 flat beds for COVID, according to hospital data.
Registered nurse Robert Luckey said he and his coworkers benefited from learning to manage the coronavirus before beds began to fill, making it feel more stable than the reported numbers.
“I don’t think we felt the blow, with the number of cases they are reporting,” he said after leaving a patient’s pressure-sealed room, which keeps the COVID-tinged air contained inside. “It’s kind of a lifestyle right now.”
That does not lessen the severity of the virus, which is approaching a dangerous level in Houston, hospital officials said. But they repeatedly stated that they felt they had enough space to accommodate the growing number of cases at Memorial Hermann. Sixteen more beds will be available in an unused wing on Monday, and another 54 are also available.
Seeing the need for more care in Houston can be frustrating because much of the spread of the coronavirus is preventable, said Mechele Jenkins, manager of the nursing floor.
“Some people, because they don’t see what we see every day, they don’t necessarily think wearing a mask is so important because they can be a healthy person,” he said. “The person next to you may not be as healthy.”
Caring for any COVID patient remains risky for medical professionals, but Doshi and his colleagues on the eighth floor have their new procedures in a science. They try to limit the frequency of visits to the room and can infuse patients with pumps that extend outside the door, instead of the usual place next to their bed.
They wear masks at all times and put on their gowns and gloves only when they enter patient rooms. They collect to-do lists on the glass and when a nurse or resident is inside, they can communicate by writing on the wall.
That kind of precaution almost amounts to a doubt that is unfamiliar to doctors.
“I never, ever thought of myself when I see patients,” Doshi said. “It goes against everything we’ve done.”
‘Angels walking among us’
With an intake of COVID patients that has become increasingly regular, Doshi said he felt lucky Thursday when the emergency room had no one waiting for a place in the ICU. Staff are always looking for openings to transfer their patients, from the emergency room to the ICU, from the general floor to an ICU overflow, or from the ICU to the general floor.
Jorge Zambra was a person who was well enough to leave his ICU bed on Wednesday night after eight days in hospital. On Thursday, in the medical intermediate care unit, he seemed fatigued, his breathing was difficult with a long conversation.
His diagnosis started with the worst headache of his life and led to hospitalization after a sudden drop in oxygen levels.
She never gave up hope, the 70-year-old said, despite the experience being a “real nightmare.”
“One minute you think you feel better than the next two hours and you start going south again,” Zambra said. “They tell me that the worst is probably over, but the recovery will be very long. Because I’m exhausted. “
Like all people hospitalized with COVID, Zambra’s stories pointed to the human cost of the disease: how he misses the interaction, how the disease has temporarily stripped his personality.
Time moves slowly in the hospital. Zambra, a semi-retired UT health department administrator, prays frequently, texts his family and friends, and watches a Memorial Hermann channel on his television that plays calming music and displays beautiful scenery.
When discharged, Zambra can’t wait to resume his piano lessons and rehearse his Spanish theater group’s upcoming play on obsessive compulsive disorder.
He still has a way to go before that happens, but his chest heaves with excitement just thinking about the gratitude he owes to the people in the hospital who saved his life.
“The ‘thank you’ I feel is bigger than Reliant Stadium,” he said. “I never knew there were so many angels walking among us.”